A new recommendation that aims to prevent peanut allergies in children is already changing the approach of local pediatricians.

Released this week, the set of guidelines from the National Institute of Allergy and Infectious Diseases recommends that doctors begin introducing some infants to peanut-containing foods when they’re as young as 4 months of age. This strategy follows a seminal paper published in 2015 that showed early introduction of peanuts can desensitize the immune systems of children who are particularly susceptible to the allergy.

Rady Children’s Hospital San Diego has begun putting the new protocol into practice, said Dr. Lawrence Eichenfield, Rady’s chief of dermatology and part of the national panel of experts who voted to make the recommendation.

“We’ve already started to identify those patients who are at highest risk and have already started to change the standards,” Eichenfield said.

The latest guidelines separate children into three categories of risk based on the presence of certain medical conditions known to be strong signals that a young child has a high chance of developing a peanut allergy.

The key markers are eczema, which causes scaly skin rashes, and egg allergies. Parents of babies with either or both of these conditions are urged to give their infants some easily digestible peanut products when the children are between 4 and 6 months old — but only after these patients have undergone at least one medical test to make sure they’ve not already developed a peanut allergy.

For this highest-risk group, Eichenfield stressed that such testing is critical. A pediatrician or allergist must be involved in the process, he said.

For children who have mild eczema or none of the risk factors, experts advise their parents to begin giving them appropriate snacks that contain peanut protein at 6 months or older.

Dr. Michael Welch, co-director of Rady’s Allergy and Asthma Medical Group, said the latest approach can sometimes create a little friction, or at least a little extra work, for families that already have one child with a known peanut allergy and are told they should start a new baby on peanut protein halfway through his or her first year of life.

“A lot of these families don’t want peanuts in the house. I had a mom who would go to the park to give peanut protein to the infant because the older child had a peanut allergy,” Welch said.

He noted that the biggest change will be for front-line pediatricians, who now have a formal, evidence-based foundation to recommend that even babies with no risk factors be given some snacks with peanut protein.

Putting this revamped standard into practice in a broad-based way, he added, has the biggest potential to significantly reduce the overall numbers of children who develop peanut allergies. It is clear, he noted, that many children will develop peanut allergies even if they don’t have risk factors such as severe eczema and egg allergies.

“I think the bigger implication here, and the potential for making a difference, is in that wider group of children who aren’t necessarily at risk. (They) can make a big difference in reducing the amount of peanut allergy we are seeing,” Welch said.

The Israelis have a big head start in giving peanut protein in a form that can be consumed by youngsters who may still be working on their first tooth.

Several years ago, researchers noticed that children in the United Kingdom have peanut-allergy rates 10 times higher than those in Israel. When they looked closer, they found that Israeli kids were often given Bamba snacks, a light but crunchy treat made from peanut butter and puffed corn, starting at about 7 months of age.

A formal clinical trial involving 530 children showed that among those who ate Bamba, only 1.9 percent developed peanut allergies, compared with 13.7 percent who didn’t.

Welch said Bamba can be found in supermarkets across the San Diego region, typically in the specialty foods aisle.

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